Neonatal Abstinence Syndrome: Newborns, Opioids & Simulation

Sep 11, 2019 | Roxanne Blanford

As many now know, there is a massive opioid epidemic in the United States and Canada, adversely impacting families, healthcare organizations, and threatening the lives of innocent newborns who become victims of the crisis.

Statistics from the Centers for Disease Control and Prevention (CDC) state that a least one baby a day is born in the USA who is suffering from intrauterine opioid exposure and subsequent drug withdrawal symptoms. Other reports estimate that number to be closer to one opioid-impacted child being born every 15 minutes1.

Opioid drug use during pregnancy can result in neonatal abstinence syndrome or neonatal opioid withdrawal syndrome (NAS/NOWS), a condition wherein a newborn infant manifests signs of clinical addition and acute toxicity upon cessation of being in the womb. In short, the neonate enters the world dependent the same drug that its mother has been using.

What Happens During Neonatal Abstinence Syndrome (NAS)?

When a developing baby is born after ongoing, prenatal exposure to opiates/opioids (such as codeine, fentanyl, hydrocodone, oxycodone, heroin, morphine, etc), its nervous system becomes over stimulated.

The newborn infant is not only trying to transition to life outside of the womb, but it is also transitioning to a state where it no longer has exposure to the drug to which it has become addicted. As a result of being cutoff from this steady supply (whether from illicit use or by prescription), and no longer being fed opioids that have been passing through the placenta along with essential oxygen and nutrients, the baby experiences severe disturbances that often involve gastrointestinal, neurologic, vasomotor and respiratory systems.

Assessment and treatment of newborns with NAS can pose a great challenge to maternal-child caregivers/ neonatal nurses who lack either sufficient clinical education or real clinical hours working with neonates in crisis. High-quality, simulation-based healthcare training in neonatal healthcare can offer realistic training experience and induce a favorable, heightened sense of presence in learners.

This presence, or the sense of being there and being engaged with the patient for the benefit of the therapeutic relationship (Convington, 2003; Welch & Wellard, 2005), enables the learner to suspend disbelief. He/she will then perform as if he/she were in an actual clinical environment.

When learning to manage the delicate and sensitive procedures associated with neonatal intensive care training, including NAS protocols, realism and presence in the simulation encounter are both crucial for promoting deep, real-life learning that is carried over to the clinical setting. Retention of clinical knowledge, stronger critical thinking skills and confidence in infant patient care behaviors are the result.

Possessing these attributes is essential to providing better healthcare and saving babies' lives.

As prescription-fueled opioid abuse spirals out of control, the community-at-large recognizes the need to address the harm done to infants, the impact of NAS (in the short-term, as well as throughout a child's development), and how healthcare providers can manage the immediate clinical crisis of a baby at heightened risk for death and/or long-lasting deficits to its physical and cognitive well-being.